Spread of NDM-producing Klebsiella pneumoniae in a tertiary Greek hospital

2021 ◽  
Author(s):  
Κonstantina Kontopoulou ◽  
Georgios Meletis ◽  
Styliani Pappa ◽  
Sofia Zotou ◽  
Katerina Tsioka ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Rapd Analysis ◽  
Random Amplified Polymorphic Dna ◽  
Hospital Setting ◽  
Tertiary Hospital ◽  
Whole Genome Sequence ◽  
Health Concern ◽  
Resistant Bacteria ◽  
New Delhi ◽  
Whole Genome

AbstractBacterial carbapenem resistance, especially when mediated by transferable carbapenemases, is of important public health concern. An increased number of metallo-β-lactamase (MBL)-producing Klebsiella pneumoniae strains isolated in a tertiary hospital in Thessaloniki, Greece, called for further genetic investigation.The study included 29 non-repetitive carbapenem resistant K. pneumoniae isolates phenotypically characterized as MBL-producers collected in a tertiary hospital in Greece. The isolates were screened for the detection of carbapenemase genes (K. pneumoniae carbapenemase (blaKPC), Verona-integron-encoded MBL-1 (blaVIM-1), imipenemase (blaIMP), oxacillinase-48 (blaOXA-48) and New Delhi MBL (blaNDM)). The genetic relationship of the isolates was determined by Random Amplified Polymorphic DNA (RAPD) analysis. The whole genome sequences (WGS) from two NDM-positive K. pneumoniae isolates were further characterized.The presence of New Delhi MBL (blaNDM) gene was confirmed in all K. pneumoniae isolates, while blaKPC and blaVIM-1 genes were co-detected in one and two isolates, respectively. The RAPD analysis showed that the isolates were clustered into two groups. The whole genome sequence analysis of two K. pneumoniae isolates revealed that they belonged to the sequence type 11, they carried the blaNDM-1 gene, and exhibited differences in the number and type of the plasmids and the resistant genes.All MBL-producing K. pneumoniae isolates of the study harbored a blaNDM gene, while WGS analysis revealed genetic diversity in resistance genes. Continuous surveillance is needed to detect the emergence of new clones in a hospital setting, while application of antimicrobial stewardship is the only way to reduce the spread of multi-resistant bacteria.

scholarly journals Visual loss from mismanaged ocular injury with foreign body impaction: A Case Report

2018 ◽  
Vol 4 (2) ◽  
pp. 198-204
Author(s):  
Ifedayo O. Akintoye ◽  
Caroline O. Adeoti
Keyword(s):  
Foreign Body ◽  
Health Workers ◽  
Hospital Setting ◽  
Tertiary Hospital ◽  
Health Concern ◽  
Ocular Injury ◽  
Eye Injuries ◽  
Health Extension Workers ◽  
Foreign Body Impaction ◽  
Upper Lid

Ocular injury occurs commonly and it may lead to visual impairment if it is not properly managed. We report the case of a 35-year old man with a retained infected ocular foreign body in his right eye following an injury. The foreign body was not discovered despite consulting non-ophthalmologists at a Maternity Centre and an Optical Shop over a period of ten days.  At presentation at the Specialist Hospital, he was unable to see with swelling of the eyelid, red eye and discharge. On examination, the visual acuity in the affected eye was NLP and an infected stick that penetrated the eyeball was discovered in the superonasal aspect of sclera covered by the swollen upper lid. This resulted in endophthalmitis, cataract and blindness of that eye. Ocular injuries must be promptly referred to the ophthalmologist for appropriate care and to prevent complications. The case clearly showed a diagnostic and therapeutic challenge for paramedics who encounter eye injuries outside the tertiary hospital setting. Therefore, this report raises public health concern intended to increase awareness on the management of eye injuries. The incorporation of Primary Eye Health into Primary Health Care along with training and re-training of Community Health Extension Workers, General Practitioners and other rural health workers cannot be overemphasized.

scholarly journals Sequence Type 273 Carbapenem-Resistant Klebsiella pneumoniae Carrying bla NDM-1 and bla IMP-4

2018 ◽  
Vol 62 (6) ◽  
Author(s):  
Lu Liu ◽  
Yu Feng ◽  
Haiyan Long ◽  
Alan McNally ◽  
Zhiyong Zong
Keyword(s):  
Klebsiella Pneumoniae ◽  
Southeast Asia ◽  
Human Blood ◽  
Sequence Type ◽  
Whole Genome Sequence ◽  
Whole Genome ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Transmissible Plasmid ◽  
Long Read

ABSTRACT A carbapenem-resistant Klebsiella pneumoniae isolate was recovered from human blood. Its whole-genome sequence was obtained using Illumina and long-read MinION sequencing. The strain belongs to sequence type 273 (ST273), which was found recently and caused an outbreak in Southeast Asia. It has two carbapenemase genes, bla NDM-1 (carried by an ST7 IncN self-transmissible plasmid) and bla IMP-4 (located on a self-transmissible IncHI5 plasmid). Non-KPC-producing ST237 may represent a lineage of carbapenem-resistant K. pneumoniae , which warrants further monitoring.

scholarly journals A public health concern: emergence of carbapenem-resistant Klebsiella pneumoniae in a public transportation environment

2020 ◽  
Vol 75 (10) ◽  
pp. 2769-2772
Author(s):  
Tingting Cao ◽  
Yuanyuan Liu ◽  
Yiming Li ◽  
Yang Wang ◽  
Zhangqi Shen ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Public Transportation ◽  
Genetic Relationships ◽  
Brain Heart Infusion ◽  
Health Concern ◽  
Resistant Bacteria ◽  
Carbapenem Resistant ◽  
Broth Microdilution Method ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Beijing Subway

Abstract Objectives This study was designed to understand the prevalence of antibiotic-resistant bacteria in the Beijing subway environment and the potential transmission of carbapenem-resistant Enterobacteriaceae in a public transportation environment. Methods Carbapenem-resistant isolates were selected on brain heart infusion agar supplemented with meropenem (0.5 mg/L) and antimicrobial susceptibility testing was conducted using the broth microdilution method. WGS analyses were conducted for 11 Klebsiella pneumoniae isolates to identify resistance genes. The genetic relationships among the isolates were evaluated by MLST and PFGE. Results We identified 11 carbapenem-resistant K. pneumoniae isolates from the Beijing subway environment. WGS revealed three STs among the 11 isolates, with 9 isolates classified as ST726 and containing a blaNDM-5-carrying IncX3 plasmid. The genetic environment of blaNDM-5 was very similar to that observed in other blaNDM-5-containing clinical isolates. Conclusions The presence of carbapenem-resistant Enterobacteriaceae in a public transportation environment is concerning and indicates that regular antimicrobial resistance surveillance is urgent and necessary.

scholarly journals Isolation and Characterization of Two Klebsiella pneumoniae Phages Encoding Divergent Depolymerases

2020 ◽  
Vol 21 (9) ◽  
pp. 3160 ◽  
Author(s):  
Pilar Domingo-Calap ◽  
Beatriz Beamud ◽  
Lucas Mora-Quilis ◽  
Fernando González-Candelas ◽  
Rafael Sanjuán
Keyword(s):  
Klebsiella Pneumoniae ◽  
Multidrug Resistant ◽  
Health Concern ◽  
Resistant Bacteria ◽  
Isolation And Characterization ◽  
The Family ◽  
Important Challenge ◽  
Tail Spike ◽  
Reference Strains

The emergence of multidrug-resistant bacteria is a major global health concern. The search for new therapies has brought bacteriophages into the spotlight, and new phages are being described as possible therapeutic agents. Among the bacteria that are most extensively resistant to current antibiotics is Klebsiella pneumoniae, whose hypervariable extracellular capsule makes treatment particularly difficult. Here, we describe two new K. pneumoniae phages, πVLC5 and πVLC6, isolated from environmental samples. These phages belong to the genus Drulisvirus within the family Podoviridae. Both phages encode a similar tail spike protein with putative depolymerase activity, which is shared among other related phages and probably determines their ability to specifically infect K. pneumoniae capsular types K22 and K37. In addition, we found that phage πVLC6 also infects capsular type K13 and is capable of striping the capsules of K. pneumoniae KL2 and KL3, although the phage was not infectious in these two strains. Genome sequence analysis suggested that the extended tropism of phage πVLC6 is conferred by a second, divergent depolymerase. Phage πVLC5 encodes yet another putative depolymerase, but we found no activity of this phage against capsular types other than K22 and K37, after testing a panel of 77 reference strains. Overall, our results confirm that most phages productively infected one or few Klebsiella capsular types. This constitutes an important challenge for clinical applications.

scholarly journals A67 Bloodstream infections by carbapenem-resistant Klebsiella pneumoniae subsp. pneumoniae: Bayesian phylogenetic analysis of whole genomes

2019 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Eleonora Cella ◽  
Davide Leoni ◽  
Walter Mirandola ◽  
Carla Fontana ◽  
Loredana Sarmati ◽  
...  
Keyword(s):  
Phylogenetic Analysis ◽  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Minimum Spanning Tree ◽  
Hospital Setting ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Epidemiological Surveillance ◽  
Health Concern ◽  
Hospital Infection Control

Abstract Bloodstream infection (BSI) caused by carbapenemase-producing Enterobacteriaceae (CPE) is a major public health concern, particularly in the hospital setting. The rapid detection of resistance patterns is of paramount importance for establishing the proper antibiotic regime. In addition, in countries where CPE are endemic, it is also important to evaluate genetic relationship among the isolates in order to trace pathogen circulation and to improve the infection control programs. This study is an application of a rapid blood culture (BC) workflow consisting of fast reporting of Gram stain results, rapid pathogen identification (using MALDI TOF technology), and a molecular assay for the detection of the major genes conferring resistance, all of them performed directly from positive BCs. The application of phylogenetic and phylodynamic analyses to bacterial whole-genome sequencing (WGS) data have become essential in the epidemiological surveillance of multidrug-resistant nosocomial pathogens. We analyzed 40 strains of Klebsiella pneumoniae subsp. pneumoniae (KP) carrying blaKPC (KP-KPC), randomly selected among 147 CPE identified from BCs collected from consecutive patients from 2013 to 2016. The number of BSIs-related CPE were 23, 31, 43, and 50 in 2013, 2014, 2015, and 2016, respectively. Among 147 CPE isolates, 143 were KP and four were Escherichia coli (EC). The gene blaKPC was detected in 117 strains of KP and in four strains of EC. Other carbapenemase genes, such as blaVIM and blaOXA-48, were detected in four and nine different isolates of KP, respectively. Moreover, 13 KP strains carried two resistance genes: twelve vehicled blaKPC plus blaVIM and one blaKPC plus blaOXA-48. Phylogenetic analysis of bacterial WGS data was used to investigate the evolution and spatial dispersion of KP in support of hospital infection control. The maximum likelihood tree showed two main clades statistically supported, with statistical support for several subclusters within as well. The minimum spanning tree showed mixing between sequences from different years and wards with only few specific groups. Bayesian analyses are ongoing, as the aid of Bayesian genomic epidemiology in combination with active microbial surveillance is highly informative regarding the development of effective infection prevention in healthcare settings or constant strain reintroduction.

scholarly journals Plasmid Dynamics in KPC-Positive Klebsiella pneumoniae during Long-Term Patient Colonization

mBio ◽  
2016 ◽  
Vol 7 (3) ◽  
Author(s):  
Sean Conlan ◽  
Morgan Park ◽  
Clayton Deming ◽  
Pamela J. Thomas ◽  
Alice C. Young ◽  
...  
Keyword(s):  
Health Care ◽  
Antibiotic Resistance ◽  
Klebsiella Pneumoniae ◽  
Health Care Facilities ◽  
Resistant Bacteria ◽  
Whole Genome ◽  
Antibiotic Resistant ◽  
Carbapenem Resistant ◽  
Clinical Center

ABSTRACT Carbapenem-resistant Klebsiella pneumoniae strains are formidable hospital pathogens that pose a serious threat to patients around the globe due to a rising incidence in health care facilities, high mortality rates associated with infection, and potential to spread antibiotic resistance to other bacterial species, such as Escherichia coli . Over 6 months in 2011, 17 patients at the National Institutes of Health (NIH) Clinical Center became colonized with a highly virulent, transmissible carbapenem-resistant strain of K. pneumoniae . Our real-time genomic sequencing tracked patient-to-patient routes of transmission and informed epidemiologists’ actions to monitor and control this outbreak. Two of these patients remained colonized with carbapenemase-producing organisms for at least 2 to 4 years, providing the opportunity to undertake a focused genomic study of long-term colonization with antibiotic-resistant bacteria. Whole-genome sequencing studies shed light on the underlying complex microbial colonization, including mixed or evolving bacterial populations and gain or loss of plasmids. Isolates from NIH patient 15 showed complex plasmid rearrangements, leaving the chromosome and the bla KPC -carrying plasmid intact but rearranging the two other plasmids of this outbreak strain. NIH patient 16 has shown continuous colonization with bla KPC -positive organisms across multiple time points spanning 2011 to 2015. Genomic studies defined a complex pattern of succession and plasmid transmission across two different K. pneumoniae sequence types and an E. coli isolate. These findings demonstrate the utility of genomic methods for understanding strain succession, genome plasticity, and long-term carriage of antibiotic-resistant organisms. IMPORTANCE In 2011, the NIH Clinical Center had a nosocomial outbreak involving 19 patients who became colonized or infected with bla KPC -positive Klebsiella pneumoniae . Patients who have intestinal colonization with bla KPC -positive K. pneumoniae are at risk for developing infections that are difficult or nearly impossible to treat with existing antibiotic options. Two of those patients remained colonized with bla KPC -positive Klebsiella pneumoniae for over a year, leading to the initiation of a detailed genomic analysis exploring mixed colonization, plasmid recombination, and plasmid diversification. Whole-genome sequence analysis identified a variety of changes, both subtle and large, in the bla KPC -positive organisms. Long-term colonization of patients with bla KPC -positive Klebsiella pneumoniae creates new opportunities for horizontal gene transfer of plasmids encoding antibiotic resistance genes and poses complications for the delivery of health care.

scholarly journals Characteristics of Carbapenemase-Producing Klebsiella pneumoniae Isolated in the Intensive Care Unit of the Largest Tertiary Hospital in Bangladesh

2021 ◽  
Vol 11 ◽  
Author(s):  
Takashi Okanda ◽  
Anwarul Haque ◽  
Takuro Koshikawa ◽  
Amirul Islam ◽  
Qumrul Huda ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Drug Resistance ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Tertiary Hospital ◽  
Antimicrobial Treatment ◽  
Antimicrobial Drug ◽  
New Delhi ◽  
Antimicrobial Drug Resistance ◽  
Sequence Types

For addressing the issue of antimicrobial drug resistance in developing countries, it is important to investigate the characteristics of carbapenemase-producing organisms. We aimed to genetically characterize a carbapenemase-producing Klebsiella pneumoniae (CPKP) isolated in the intensive care unit of a tertiary hospital in Bangladesh. The number of CPKP isolates were 43/145 (30%), of which pandrug-resistant (PDR) strains were 14%. These carbapenemases were New Delhi metallo-beta-lactamase (NDM)-1 (53%), NDM-5 (14%), oxacillinase (OXA)-181 (12%), OXA-232 (10%), NDM-5 + OXA-181 (5%), and NDM-5 + OXA-232 (2%). Many CPKP isolates harbored a variety of resistance genes, and the prevalence of 16S rRNA methyltransferase was particularly high (91%). The 43 CPKP isolates were classified into 14 different sequence types (STs), and the common STs were ST34 (26%), ST147 (16%), ST11 (9%), ST14 (9%), ST25 (7%), and ST231 (7%). In this study, PDR strains were of three types, ST147, ST231, and ST14, and their PDR rates were 57, 33, and 25%, respectively. The spread of the antimicrobial drug resistance of CPKP in Bangladesh was identified. In particular, the emergence of PDR is problem, and there may be its spread as a superbug of antimicrobial treatment.

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